Monday, September 16, 2013

Medical Mondays: Do Lobotomies Damage Memory?

Does a lobotomy destroy intelligence, knowledge and memories to a certain degree? If not, what kind of forceful brain trauma/manipulation could impair memory?

Red highlighted area shows the frontal lobe, targeted by Egas Moniz in the leucotomy pioneered in 1930's.
Source: Wikipedia

The lobotomy has an infamous history in American culture and the medical world. Briefly, it's a procedure that aims to "detach" the prefrontal cortex (basically the part of the brain closest to your forehead) from the rest of the brain.

When the lobotomy ("lobe cutting") was being developed, it was thought that the frontal lobes affected only personality, not a person's functioning intellect or memory. During a time when institutions were becoming overwhelmed with so many suffering from mental illness, there was a hope that lobotomy could treat many, reintroduce them back into society, or make them easier to care for.

In 1935, Antonio Egas Moniz performed the first surgical lobotomy (originally coined "leucotomy") and later went on to win the Nobel prize for his work (many believe this prize should be rescinded.)

In 1945 in the United States, Dr. Walter Freeman, a neuropsychiatrist, performed the first ice-pick lobotomy(using an ice pick from his own kitchen and practicing on a grapefruit first. I know; I will never eat another grapefruit without gagging a little.) The technique was to anesthestize the patient (often after shock therapy), hammer the ice pick under the eyelid, through the skull, swish it around in the frontal lobes (not being very technical here but that's what it seemed like) and it was done within minutes.

Advertisement promoting lobotomy in the American Journal of Psychiatry: Source

The results were varied. Some patients went suddenly calm and no longer had the wilder symptoms that led them to have the procedure in the first place. Their intellect stayed intact and they were able to function in society. But in the darker pages of medical history, there were many, many stories of others who became docile to the points of being unable to care for themselves at all. They couldn't function in society, being "detached" from others and being unable to think normally.

Still others died. Dr. Freeman's performed his last procedure on a women who died shortly after from a brain hemorrhage. But ultimately, it was the discovery and production of the first anti-psychotic medication in the 1950's (Thorazine, called "Lobotomy in a Pill") that eventually killed the procedure for good. But by then, close to 70,000 people worldwide, including 40,000 in the U.S. had been lobotomized. These included unhappy housewives and "difficult" children. The story of one such child named Howard Dully is told in a chilling NPR documentary (see below.)

SO! Back to the question.
So for Dani, where could you "traumatize" the brain to effect memory? Several places, depending on which kind of memory she'd like to zap away.Hippocampus ("coiled horse" in Greek, because it anatomically looks like a tiny coiled seahorse): used to turn short-term memory into long term memory; works on spatial and procedural memoryAmygdala (Greek for "almond" or tonsil, due to shape): emotional memories, fear conditioning, and long term memoryCerebellum ("little cerebrum" since it looks like a tiny brain): procedural memory. People with memory problems elsewhere but intact cerebellums would, for example, be able to perform complex piano pieces they'd learned before.Basal Ganglia: implicit memory (memory without obvious thought involved, like tying shoes or riding a bike.)Frontal Lobe: working memory, or the ability to process transient info in the present, like reasoning and comprehension.Temporal Lobes: long term memory and recognition memory, and autobiographical memory

There's more, but I think I'm already overloading your short-term memory, so I'll stop the neuroanatomy lesson here! Suffice it to say, if Dani wanted to target a specific kind of memory loss, she'd have her pick of areas in the brain. It would be fun (in an Evil Mastermind kind of way) to think of a way to physically traumatize a character's neuroanatomy to cause these sorts of memory loss.

Thanks Dani for the question!

If you want to learn more about the history of lobotomy, check out these links:

Yeah, the history of lobotomies is one of the creepier things in the world to think about. My primary school used to move around a lot and one of the sites we had our school at was an old, abandoned psych hospital. I imagine it could have been a site for any Australian lobotomies that may have occurred in the past (just guessing).

Your medical posts are always fascinating. It's hard to believe that the history of the procedure is not that ancient. Fifty or sixty years from now you have to wonder what people will think of the procedures people undergo now. Barbaric?

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